Quality of Life and Work Productivity Impairment of Patients with Allergic Occupational Rhinitis.

Background: Several studies demonstrated the negative impact of allergic rhinitis on Quality of Life (QOL) and occupational activities. Similar studies on allergic Occupational Rhinitis (OR) are rare. The aim of this study was to evaluate the QOL and work productivity of patients diagnosed with allergic occupational rhinitis. Materials and Methods: We conducted a cross-sectional study from January 2005 to December 2015 at the Department of Occupational Medicine in Farhat Hached Teaching Hospital-Tunisia including patients diagnosed with allergic OR. QOL was assessed by the Mini-RQLQ (Rhinitis quality of life questionnaire) and Work impairment was measured by WPAI (Work Productivity and Activity Impairment) questionnaire. Results: a total of 414 patients was enrolled in the study with a mean age of 37.82±8.08 years and a sex ratio = 0.33. Textile and clothing industry was the most represented sector (65.7%). The mean percent work time missed (absenteeism) due to allergic OR was 9.98±20.86% with a median of 0% and the mean presenteeism score was 46.7±32.67%. Overall QOL was 2.71±1.31. The most affected domains were practical problems and activity limitations. Absenteeism was positively correlated with age and eye symptoms scores. Both presenteeism and percent overall activity impairment were positively correlated with severe nasal obstruction and activity limitations score. Conclusion: Allergic OR impairs QOL and work productivity. Although it doesn’t seem to be associated with an important absenteeism, work productivity is reduced by an important rate of presenteeism. QOL and work productivity seem to interact significantly.


INTRODUCTION
Rhinitis is defined as an inflammation of nasal mucosa, characterized by nasal symptoms such as nasal airflow limitation, anterior and/or posterior rhinorrhea, nasal pruritus and sneezing (1).
Occupational Rhinitis (OR) is an inflammatory disease of the nose, which is characterized by intermittent or persistent symptoms (i.e., nasal congestion, sneezing, rhinorrhea, itching), and/or variable nasal airflow limitation and/or hypersecretion arising out of causes and conditions attributable to a particular work environment and not to stimuli encountered outside the workplace (2).

TANAFFOS
Allergic rhinitis affects 10 to 25% of the population in developed countries and its prevalence is growing in developing countries (4)(5)(6)(7). Its prevalence is about 15% in Switzerland and 20% in Europe (8). Epidemiological data available in Switzerland since 1926 have shown an increasing amount of sensitization to pollens from 1 to 12% within 70 years (8 show a small number of declared cases underlining an under-declaration (10).
The evolution of Allergic OR to asthma is well-known and rhinitis is often preceding asthmatic symptoms (11).
However, OR is 2 to 3 times more frequent than occupational asthma (12).
Allergic rhinitis is a public health concern due to its prevalence, costs, association with asthma and negative impact on Quality of Life (QOL) and work abilities (13).
Therefore, we conducted this study with the objectives of evaluating QOL and productivity of patients with allergic occupational rhinitis.

Statistical analysis
Means, standard deviations, medians and extreme values were calculated for quantitative variables.
Frequencies and percentages were calculated for qualitative variables.
Pearson correlation coefficient was used to explore the correlation between two quantitative variables. Student's ttest for the comparison of two means and Snedecor's F test for the comparison of several means were performed.
Multiple linear regressions were conducted for multivariate analysis. For all statistical tests, the threshold of significance (P-value) was set to 0.05. and only 12 patients were highly qualified (2.9%). Table 1 shows occupational sectors of the cases with a clear predominance of the clothing and textile sector. Only 32 patients were smokers (7.7%) and six patients were exposed to passive smoking (1.4%).

Sociodemographic and medical characteristics
The delay between the first occupational exposure and the onset of rhinitis ranged from 1 month to 32 years with an average of 9.84 ± 7.69 years.

QOL and work productivity and activity impairment:
Overall QOL score was 2.71±1.31. The most affected domains were practical problems and activity limitations (   positively correlated with severe nasal obstruction on rhinomanometry and activity limitations score (Table 5).  In our study, female workers had more impaired QOL scores. Housekeeping activities, which were evaluated by the questionnaire may explain a part of this findings.
Women are generally cumulating efforts at work and at home and are exposed to household products that can aggravate rhinitis symptoms, impacting QOL.
These findings were similar to those reported by Compared to other diseases, allergic rhinitis seemed to have more negative impact on work productivity and activity than hypertension and diabetes and only depression caused more impairment than allergic rhinitis in the study of De la Hoz Caballer (20).
Our study showed associations between QOL and work productivity among patients with allergic OR. Even if absenteeism rates seem to be moderate, work productivity is clearly reduced because of important presenteeism percentages.
Identification of factors such as age, gender and QOL impairment could help to identify workers with higher risk of productivity and activity impairment. A rigorous application of preventive measures and a medical control of the disease should reduce the burden of allergic occupational rhinitis and also improve QOL and work productivity.

CONCLUSION
Allergic OR impairs QOL and work productivity.
Although it doesn't seem to be associated with an important absenteeism, work productivity is reduced by an important rate of presenteeism. QOL and work productivity seem to interact significantly.
Only few studies were conducted to evaluate the impact of allergic OR on QOL and/or work productivity.
This subject needs to be more explored for many reasons: the important incidence of the disease in various occupational sectors, its negative repercussions on QOL and on productivity, and the expected positive contribution of prevention and treatment in the improvement of social and economic aspects associated with occupational OR.